A retrospective study of 20 consecutive patients with cerebral vascular malformations who were treated surgically for medically refractory partial epilepsy is reported from the Departments of Neurology and Neurologic Surgery, Mayo Clinic, Rochester, MN. MRI was more sensitive than CT and showed 36 vascular malformations (32 cavernous and 4 A-V malformations). Previous hemorrhage was verified in 18 patients. After complete resection of the lesion, 15 patients were free of seizures and 3 had a 90% control. Age of onset and duration of seizures did not affect outcome. A focal corticectomy in addition to lesionectomy was necessary in 11 patients with MRI-disclosed ipsilateral medial temporal lobe atrophy. [1]
COMMENT. The authors advocate early surgical intervention and excision of the lesion in patients with refractory partial seizures associated with vascular malformations. Corticectomy may be necessary in patients with dual temporal lobe pathologies.